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Youth mental health concerns are rising and often present as internalizing or externalizing behaviors that can lead to a host of negative academic, social, and health outcomes, especially for marginalized students. Despite the growing mental health needs, many youth face barriers to accessing traditional mental health care, highlighting the importance of school-based mental health services.

This paper contributes to understanding Multitiered Systems of Support (MTSS), an evidence-based framework, by reviewing its application within the school context and opportunities to increase students' equitable access to mental health supports.

This paper provides recommendations for evidence-based screening measures and some evidence-based prevention and intervention services that can be utilized and delivered in schools. Implications for how workforce diversity, professional development, and supportive policies can strengthen MTSS implementation by promoting inclusive, trauma-informed care and fostering collaboration among schools, families, and communities to enhance student well-being and equity are also reviewed.

School-based mental health services that utilize MTSS and center equity are imperative for addressing the rising mental health concerns among youth.